Information Technology
Business Analyst, Medicaid Encounters
Pune, Maharashtra, India


Business Analyst, Medicaid Encounters


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Business Analyst, Medicaid Encounters



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It’s Time For A Change…

Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

Are we growing? Absolutelyabout 40% in year-over-year revenue growth in 2018. Are we recognized? Definitely. We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019, and One of the “50 Great Places to Work” in 2017 by Washingtonian. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.


What You’ll Be Doing:

Medicaid Encounter Operations, Health Plan Services (HPS) is responsible for managing day to day operations for a state’ Medicaid encounters on behalf of Evolent clients.  Operational areas of responsibility include encounter data management, submissions, reject remediation, and client/internal reporting as well as coordination/reconciliation with state regulatory bodies.

This individual must be experienced in managing day to day encounter operations around state Medicaid encounter submissions.  This position will report to the Director or Associate Director of Encounter Operations and is located in the Chicago, IL area.


  •              Responsible for timely, complete, and accurate encounter data submissions that meet or exceed state and/or federal requirements
  •              Work with HPS Business Operations and IT Engineering to implement a strategic approach to encounter data management encompassing internal and external data sources, technical infrastructure, process automation, and issue/reject remediation workflow
  •              Identify, develop and drive initiatives to increase the Encounter Operations function regulatory compliance levels, productivity/efficiency, process consistency, and long-term scalability
  •              Oversee the on-boarding of new encounter clients to include requirements gathering/documentation and coordination with HPS Implementation, Business Operations, and/or HPS Engineering teams (as required)
  •              Develop and execute action plans to respond to new encounter regulatory requirements
  •              Efficiently and effectively manage internal and external escalations
  •              Data management and analysis reporting utilizing SQL, Microstrategy and similar reporting tools
  •              Medicaid Encounter management and processing utilizing EDIFECS Encounter Management platform
  •              Data movement and transformation utilizing Move-IT and SSIS  and SFTP protocols , processes and tools

The Experience You’ll Need (Required):

  •              Understanding and experience with standard claim Electronic Data Interchange file formats and protocols such as 837I, 835, 277, 999 among others
  •              Bachelor’s degree in Healthcare Management, Computer Science or another technology/business field of study
  •              Hands-on experience with EDI X12 837 transaction set.
  •              Experience Monitoring, troubleshooting, and correcting EDI transactions in Encounter Management Platform.
  •              Excellent analytical and problem-solving skills in Healthcare data operations, specifically with Claims and Encounters data.
  •              Experience working with TPA and establishing Third Party Vendors EDI contractors – Encounter Data submission.
  •              Experience working with Request Management tools like HP QC, ReqPro, JIRA,  or similar industry standard tools.
  •              Ability to perform typical business analyst duties such as requirements gathering, solution design, testing to meet business needs.
  •              End to End knowledge of Healthcare Payer data operations.
  •              Experience working in Government Programs – Medicaid/Medicare.
  •              Strong SQL Server Management Studio experience or similar products.
  •              3-5 yrs experience in leading Medicaid encounter operations, Indiana Medicaid a plus
  •              Experience in healthcare payer systems required and knowledge of Medicaid products and programs preferred

Finishing Touches (Preferred):

  •              Process orientation with strong organizational/leadership and analytic skills (troubleshooting, attention to detail)
  •              Strong verbal and written communication skills for internal and external (clients, state bodies, vendors)

Evolent Health is an Equal Opportunity/Affirmative Action Employer


Work Environment:The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This position primarily works in a climate controlled based setting.The noise level and the work environment are moderately quiet. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines

Physical demand: Include the physical demands of the job, including bending, sitting, lifting and driving.  For example, while performing the duties of this job, the employee is regularly required to talk or hear.  The employee frequently is required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms.  

Why Join Evolent?Evolent Health developed an integrated value-based care platform for payers and providers. The company created an internal recognition program that encourages departments to acknowledge outstanding achievement as well as focusing on philanthropic values. The company spent four weeks in 2018 giving back to more than 60 local charities and engaged 3,700-plus employees to participate. Evolent provides healthy snacks and drinks in most of its offices as well as an in-office gym at its headquarters and workstations that include treadmill desks. In 2016, the company launched its diversity and inclusion committee that promotes unconscious bias training and established several business resource groups. In 2017, Washingtonian Magazine named Evolent among the 50 Great Places to Work.


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